| NPI | 1700112208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME153534) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PAT9105097) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2021-11-18 |